Research Cooperative Agreements

Research Group

NIOSH has funded research projects and epidemiologic studies designed to help answer critical questions about physical and mental health conditions related to the September 2001 terrorist attacks. The areas of interest for these studies include: biomarkers of exposures or health outcomes; epidemiologic studies; exposure-response relationships; improvements in diagnosis and treatment; patterns of illness (age, gender, etc.); risk factors for disease; and other research studies on WTC-related health conditions or emerging conditions.

Below is a list of projects and studies currently underway. Included in the list is a description, the name of the principle investigator, and contact information for each project:

Information on Research Funding Opportunities

At the current time, there are no research funding opportunities available for the WTC Health Program. We do anticipate that opportunities will be available during 2014. Please refer back to this page for additional information when the opportunity becomes available.

Research Meeting Proceedings

Through funding made available by the James Zadroga 9/11 Health and Compensation Act of 2010, NIOSH has awarded research grants to dozens of researchers to study the mental and physical health consequences of the September 11, 2001, terrorist attacks. View the results of that research

Agreements Awarded in FY 2015

A Pilot Test of the Relaxation Response Resiliency Program (3RP) in Spanish Speaking World Trade Center Disaster Survivors with PTSD(See more / See less)

Project Number: 1U01-OH0 10996-01Institution: New York University School of Medicine Principal Investigator: Lucia Ferri, PhDPhone Number: 212-562-1735Email: Lucia.Ferri@bellevue.nychhc.orgProject Duration: 1 yearDescription:
Individuals directly exposed to 9/11 World Trade Center (WTC) disaster, including community members who lived or worked in the area, continue to experience significant psychiatric and physical health symptoms. At the WTC Environmental Health Center, at least one-third of patients serviced are Hispanic with Spanish as their primary language. Unfortunately, there are limited empirically supported treatment protocols that are translated and available in Spanish for this population. This study will adapt and translate the Relaxation Response Resiliency Program (3RP), a comprehensive mind-body treatment, for Spanish-speaking WTC survivors. We will evaluate whether the treatment is acceptable and feasible for this population.

Childhood Exposures to Persistent Organic Pollutants in the World Trade
Center Disaster and Cardiovascular Consequences
(See more / See less)

Project Number: 1U01-OH010714-01A1Institution: New York University School of Medicine Principal Investigator: Leonardo Trasande, MD, MPPPhone Number: 646-501-2520 Email: leonardo.trasande@nyumc.orgProject Duration: 1 yearDescription:
The study builds upon a NIOSH-supported study of World Trade Center (WTC)-exposed adolescents to assess whether persistent organic pollutant exposures are potentially contributors to cardiometabolic conditions in adolescents. If these exposures are associated with cardiometabolic consequences and with reported exposure to the disaster, these findings will enhance understanding of WTC-associated conditions and guide proactive screening and management of future disasters.

Project Number: 1U01-OH0 10993-01 Institution: Albert Einstein College of MedicinePrincipal Investigator: Thomas Aldrich, MDPhone Number: 718-920-6087 (office); 914 262 8855 (cell)Email: taldrich@montefiore.orgProject Duration: 1 yearDescription:
Sarcoidosis, an inflammatory disease of unknown cause that can affect almost any organ, has been noted in unexpectedly large numbers of World Trade Center (WTC)-exposed persons, including 76 FDNY firefighters. This project is a detailed re-examination of this group, to define their clinical patterns and genetic markers and compare them with those of previously reported non-WTC-exposed sarcoidosis patients. We will also assess genetic differences with similarly WTC-exposed firefighters who did not develop sarcoidosis. The results should help to determine the extent and severity of sarcoidosis triggered by a unique occupational exposure.

Cognitive Function among World Trade Center Rescue and Recovery Workers
- Direct Effect or Mediation through Comorbidities
(See more / See less)

Project Number: 1U01-OH0 10988-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Cheryl Stein, PhDPhone Number: 212-824-7083Email: Cheryl.Stein@mssm.eduProject Duration: 1 yearDescription:
The main goal of the study is to use existing, longitudinal data from the New York City Region Clinical Centers of Excellence to examine the association between World Trade Center (WTC) exposure and cognitive function among the nearly 25,000 rescue and recovery workers participating in the WTC Health Program. First we want to determine whether there is evidence of cognitive dysfunction among rescue and recovery workers. Then if there is evidence of cognitive dysfunction, we will try to tease apart whether the dysfunction is due to WTC exposure (e.g., dust, chemicals), WTC-related illness (e.g., cardiovascular disease, depression), or both.

Project Number: 1U01-OH0 10721-01A1Institution: New York State Psychiatric InstitutePrincipal Investigator: Christina W. Hoven, DrPH, MPHPhone Number: 646-774-5800Email: ch42@columbia.eduProject Duration: 1 yearDescription:
The Trauma, Context and Outcome (TCO) study will identify the role that race/ethnicity, interacting with family and neighborhood contextual factors, had on the mental health outcomes of youth exposed to 9/11 and will contribute to the NIOSH World Trade Center (WTC) Health Program. This study will clarify the role that children's context played in determining if they had a resilient, versus an adverse response to 9/11. This understanding is key to the development of improved and targeted prevention and treatment strategies, as well as public policies, for all children exposed to mass trauma, but especially minority populations.

Project Number: 1U01-OH 010987-01 Institution: Icahn School of Medicine at Mount Sinai Principal Investigator: Paolo Boffetta, MDPhone Number: 212-659-1474Email: paolo.boffetta@mssm.eduProject Duration: 1 yearDescription:
The project aims at correlating a detailed assessment of exposure of World Trade Center (WTC) responders enrolled at program at Stony Brook with alterations the mechanism of regulation of DNA called methylation, which may be relevant to cancer risk. The project is expected to contribute to understanding of the possible role of DNA methylation as marker of exposure to carcinogenic exposure among WTC responders. If the results confirm a correlation between WTC exposures, assessed through a high-quality methodology, and altered DNA methylation, they might lead to the development of strategies to identify WTC responders at increased risk of cancer and other chronic diseases.

Project Number: 1U01-OH010986-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Adriana Feder, MDPhone Number: 212-659-9145Email: adriana.feder@mssm.eduProject Duration: 1 yearDescription:
Post-traumatic stress disorder (PTSD) arising in response to the World Trade Center (WTC) disaster is one of the most prevalent and persistent psychiatric disorders among workers involved in rescue, recovery, and clean-up efforts, even over a decade after 9/11. This study involves a comprehensive, multi-modal, and integrative assessment of biomarkers implicated in the pathophysiology of PTSD, including measuring differences in whole-blood gene expression and other blood biomarkers of key neurobiological systems, an approach critical to informing risk and resilience prediction algorithms for PTSD, and to develop novel psychopharmacologic approaches for the treatment of this disabling condition in disaster responders and other trauma survivors.

Agreements Awarded in FY 2014

Project Number: 1U01 OH010730-01Institution:North Shore-LIJ Health SystemPrincipal Investigator: Hyun Kim, ScDPhone Number: 516-465-2517Email:hkim8@nshs.eduProject Duration: 2 yearsDescription:
The main goal of the study is to assess the impacts of epidemiologic biases in WTC health studies by identifying the presence of bias and then by quantifying and adjusting for the bias effects. The successful completion of the bias analysis will assist other researchers to draw plausible inference of WTC health effects and other future disaster studies by adjusting for bias.

Project Number: 1U01-OH010512-01A1Institution: Feinstein Institute for Medical ResearchPrincipal Investigator: Emanuela Taioli, MD, PhDPhone Number: 516-465-3093Email:etaioli@nshs.eduProject Duration: 2 yearsDescription:
The current project aims to establish a biorepository of cancer tissue samples from World Trade Center (WTC) Responders. This biorepository will consolidate tissue samples from all those in the WTC cohort that consent to participate. These samples will be stored in a centralized location, de-identified, and catalogued. This will allow for future research into WTC-specific mechanisms involved in cancer development, and will result in improved treatment options for WTC responders. Procedures will be implemented to review and grant/deny requests for use of samples in biomedical research based on a rigorous review.

Deciphering Biological Linkages between PTSD and Respiratory Disease in WTC Responders(See more / See less)

Project Number: 1U01 OH010718-01Institution: State University New York Stony BrookPrincipal Investigator: Benjamin Luft, MDPhone Number: 631-855-1200Email:benjamin.luft@stonybrookmedicine.eduProject Duration: 2 yearsDescription:
The September 11, 2001 terrorist attack on the World Trade Center was an extraordinary environmental disaster resulting in an unprecedented combination of physical and emotional trauma. As many as 60% of responders will experience clinically significant symptoms, most prominently PTSD and lower respiratory symptoms (LRS). Our group found that PTSD is not only associated with LRS but may contribute to the development of these symptoms as well as diminish their response to treatment. We have performed epigenetic studies and are beginning to untangle the genes responsible for this association. The study will extend these findings to identify the precise cell where these pathogenic relationships are occurring. Ultimately, this knowledge will lead to the development of better diagnostics and more specific treatment for this disease process.

Project Number: 1U01 OH010726-01Institution: New York University School of MedicinePrincipal Investigator: Michael Weiden, MDPhone Number: 212-263-6479Email:michael.weiden@nyumc.orgProject Duration: 2 yearsDescription:
Early neutrophil concentrations in blood drawn within 6 months of exposure were a risk factor for progressive sinusitis. Despite treatment, those affected continue to experience morbidity and reduced quality of life, while screening continues to identify new cases. Development of models, using an inexpensive, biomarker (CBC) that predicts disease severity and progression may enable earlier and more aggressive interventions to improve the health of WTC-exposed subjects. This may improve the quality of life of those with high risk of proceeding to sinus surgery. This may also avoid radiation exposure to those at low risk.

Project Number: 1U01 OH010711-01Institution: Albert Einstein College of MedicinePrincipal Investigator: Charles B. Hall, PhDPhone Number: 917-803-5470Email:charles.hall@einstein.yu.eduProject Duration: 2 yearsDescription:
This study will use innovative statistical methods to examine the temporal patterns in the association between the effects of rescue/recovery work at the World Trade Center (WTC) by FDNY firefighters on the incidence of physician-diagnosed chronic rhinosinusitis (CRS) and on self-reported persistent rhinosinusitis symptoms. Specifically, we will use parametric survival models with change points to determine whether the exposure-response relationship persists for years after exposure or becomes attenuated after some time.

Mental Health Impact and Service Use among Asian Survivors and Rescuers Exposed to the WTC Attack(See more / See less)

Project Number: 1U01 OH010516-01A1Institution: Fordham UniversityPrincipal Investigator: Winnie Kung, PhDPhone Number: 347-239-1717Email:kung@fordham.eduProject Duration: 2 yearsDescription:
This study attempts to assess the short-, medium-, and long-term mental health impact of the World Trade Center attack on Asian Americans. The course of the psychological distress and its related risk factors will be explored, and the pattern is compared to that of the Whites. It also examines Asians' mental health service use patterns and the facilitating factors and barriers to help seeking. It has important policy implications in improving treatment access to this sizeable but understudied subgroup affected by the attack, which has a history of being the lowest mental health service users compared to other races.

Project Number: 1U01-OH010728Institution: Albert Einstein College of MedicinePrincipal Investigator: Mayris Webber, DrPHPhone Number: 718-999-2665Email:webberm@fdny.nyc.govProject Duration: 2 yearsDescription:
Modest elevations in cancer rates post-exposure to the World Trade Center (WTC) site have been reported in all three cohorts of rescue/recovery workers. The overarching goal of this study is to improve understanding of the association between WTC exposure and cancer risk. We will: 1) Compare cancer rates in WTC-exposed NYC firefighters to rates in non-WTC-exposed firefighters; 2) Develop a new exposure measure based on work records and model cancer incidence rates as a function of both time of first arrival at the WTC site and the new duration measure; and, 3) Estimate the future cancer burden of WTC-exposed firefighters.

Renal and Cardiovascular Impairment in WTC Responders: Implications for Diagnosis and Treatment(See more / See less)

Project Number: 1U01 OH010716-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Maryann McLaughlin, MD, MPHPhone Number: 1-866-537-7107Email:cynara.maceda@mssm.edu or heather.n.beebe@mssm.eduProject Duration: 2 yearsDescription:
Environmental toxins exert damaging health effects in workers. Volunteers of the WTC rescue and recovery effort following WTC attacks may be at increased risk for worsening health. The goal of this study is to quantify the risk of kidney damage among first responders to the WTC attack and determine its relationship to particulate matter exposure. We hypothesize that exposure to inhaled particulate matter causes systemic inflammation and endothelial dysfunction that result in chronic kidney and cardiovascular damage. Knowledge to be gained from this study can influence strategies to minimize the risk of chronic kidney and cardiovascular disease among first responders.

Project Number: 1U01 OH010712-01Institution: State University New York Stony BrookPrincipal Investigator: Roman Kotov, PhDPhone Number: 631-632-7763Email:Roman.Kotov@stonybrook.eduProject Duration: 2 yearsDescription:
Comorbid post-traumatic stress disorder (PTSD) and lower respiratory symptoms (LRS) are among the most common and persistent health burdens faced by World Trade Center (WTC) responders following the attacks on 9/11. For the first time, the study will use ecological momentary assessment approach to survey WTC responders in real time about the prevalence, burden and the sequence of PTSD and LRS, and to test biological processes involved.

Project Number: 1U01 OH010722-01Institution: Center for the Biology of Natural Systems (CBNS) Queens College-CUNYPrincipal Investigator: Alfredo Morabia, MDPhone Number: 718-670-4182Email:zlaskaris@qc.cuny.edu or alfredo.morabia@qc.cuny.eduProject Duration: 2 yearsDescription:
Several research studies indicate that people working or residing near Ground Zero in 2001-2002 are at increased risk of cardiovascular disease (CVD). It is hypothesized that this increased risk is a result of exposure to the dust and gases liberated by the destruction of the twin towers and/or the psychological stress of working in such a dramatic human and environmental disaster. WTC-Heart (n=6,481) is a rigorous cohort study comprised of responders and volunteers recruited at the WTC Health Program. WTC-Heart will provide unique evidence of observed CVD risk and predicted CVD risk in WTC responders to guide the implementation of preventive interventions.

Agreements Awarded in FY 2013

Project Number: 1U01-OH010394-01A1Institution: New York University School of MedicinePrincipal Investigator: Leonardo Trasande, MD, MPPPhone Number: 646-501-2520Email:leonardo.trasande@nyumc.orgProject Duration: 3 yearsDescription:
This study builds on preliminary studies in self-selected populations to identify opportunities for early identification of WTC-related health consequences in adolescents. If adverse health consequences are identified, proactive cardiometabolic and pulmonary screening of exposed children may be indicated, with targeted interventions intended to prevent development of chronic obstructive pulmonary disease, and adverse cardiometabolic outcomes in adulthood.

Project Number: 1U01-OH010524Institution: State University New York Stony BrookPrincipal Investigator: Adam Gonzalez, PhDPhone Number: 631-855-1233Email:adam.gonzalez@stonybrook.eduProject Duration: 3 yearsDescription:
Comorbid PTSD and respiratory illness continue to burden WTC responders over a decade post disaster, despite pharmaceutical and psychotherapeutic treatment efforts. Mind-body treatments have demonstrated promise for reducing both PTSD and respiratory symptoms, and potential biological markers underlying these conditions; however no randomized control trial (RCT) has evaluated this treatment approach among patients with comorbid PTSD and respiratory illness. This study will be the first RCT to evaluate a novel mind-body treatment among WTC responders with these comorbidities and could have important implications for health care costs, quality of life and functioning, morbidity and possibly mortality.

Project Number: 1U01-OH010513Institution: Albert Einstein College of MedicinePrincipal Investigator: Mayris Webber, DrPHPhone Number: 718-999-2665Email:webberm@fdny.nyc.govProject Duration: 2 yearsDescription:
The overall goal of this two-year study is to calculate the incidence of selected systemic autoimmune diseases (SAID) in 21,786 World Trade Center (WTC)-exposed and unexposed firefighters and emergency medical service workers and to estimate the association between intense WTC exposure and SAID. If results suggest that SAID are increased in relation to WTC exposure, FDNY and other centers of excellence could then incorporate active case finding into routine monitoring visits, facilitating early detection and treatment, which has been shown to reduce end-organ damage and improve quality of life.

Project Number: 1U01-OH010396-01A1Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Emanuela Taioli, MD, PhDPhone Number: 516-465-3093Email:emanuela.taioli@mssm.eduProject Duration: 2 yearsDescription:
This study represents the first in-depth analysis of prostate cancer among WTC rescue and recovery workers. The study results will have practical implications on the surveillance and clinical management of prostate cancer, which is the most common cancer among male WTCHP members. The study will generate novel data on biomarkers of prostate cancer aggressiveness that could be used to make decisions on clinical treatment.

Project Number: 1U01-OH010395-01A1Institution: New York University School of MedicinePrincipal Investigator: Michael Marmor, PhDPhone Number: 212-263-6667Email:michael.marmor@nyumc.orgProject Duration: 2 yearsDescription:
This study will determine if WTC-related trace elements can be identified in tissues of individuals at their times of death in 2007-2012. If signature trace elements can be identified, this project will lay the foundation for future development of biomarkers indicative of cumulative exposure to WTC contaminants among living individuals. Biomarkers reflective of WTC exposures would be of value to research on the health effects of WTC exposures among first responders, residents and workers, including members of the WTCHR. They would also be helpful for the investigation and attribution of diseases among WTC-exposed individuals and may aid in the treatment of WTC-associated diseases.

Project Number: 1U01-OH010404-01A1Institution: New York University School of MedicinePrincipal Investigator: Joan Reibman, MDPhone Number: 212-263-6479Email:Joan.reibman@nyumc.orgProject Duration: 3 yearsDescription:
Many "survivors"(community members) in the WTC clinical treatment program have persistent lower respiratory symptoms (LRS) despite treatment. This study will test the hypothesis that patients with uncontrolled lower respiratory symptoms (LRS) have (despite aggressive medical therapy) increased rates of abnormal airway physiology, airway inflammation and co-morbid conditions when compared to those with controlled symptoms. Identifying these mechanisms for uncontrolled LRS is imperative to guide therapy with the important potential to reduce secondary adverse health outcomes.

Agreements Awarded in FY 2012

Project Number: 1U01 OH010407-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigators: Adriana Feder, MD, Robert Pietrzak, PhD, Steven Southwick, MDPhone Number: 212-659-9145Email:adriana.feder@mssm.eduProject Duration: 4 yearsDescription:
This study will employ a multi-level approach to study clinical, psychosocial, neuroendocrine, genotypic, gene-environment interaction, and molecular factors associated with PTSD risk and resilience in a sample of 500 WTC responders. The study will provide important information about the risk and resilience factors for PTSD in disaster responders and make possible the development of improved preventive and treatment interventions for this disorder in disaster responders and trauma-exposed individuals in general.

Project Number: 1U01 OH010411-01Institution: Albert Einstein College of Medicine Principal Investigator: Thomas Aldrich, MDPhone Number: 718-920-6087 (office); 914 262 8855 (cell)Email:taldrich@montefiore.orgProject Duration: 2 yearsDescription:
Persistent obstructive airways disease (an asthma-like condition) is common among World Trade Center exposed firefighters, though rare in this population before 9/11/2001. In about 30% there is accompanying bronchial hyperreactivity (easily triggered airway narrowing). This study will re-examine a large number of firefighters who had bronchial reactivity soon after 9/11 to determine whether those with bronchial hyper-reactivity at onset have persistent hyperactivity more than ten years later, whether they have accelerated lung function decline, and whether those treated with anti-asthma medications were more likely to show resolution of bronchial hyperactivity and/or show less rapid decline in lung function.

Project Number: 1U01 OH010416-01Institution: State University New York Stony Brook Principal Investigator: Benjamin Luft, MDPhone Number: 631-855-1200Email:benjamin.luft@stonybrookmedicine.eduProject Duration: 2 yearsDescription:
World Trade Center disaster responders exhibit persistent symptoms of post-traumatic stress disorder (PTSD) and respiratory illness linked to the severity of their exposures. One-quarter of responders affected by these conditions suffer from both, resulting in increased disability and utilization of medical services. This study will examine the potential mechanisms underlying PTSD/respiratory co-morbidity that may facilitate the development of more effective, theory-driven interventions for these difficult to treat patients.

Project Number: U50-OH009739Institution: New York City Department of Health and Mental Hygiene Principal Investigator: Mark Farfel, ScDPhone Number: 347-396-2876Email:mfarfel@health.nyc.govProject Duration: 4 years Description:
During the funding period, Registry staff will conduct priority epidemiological analyses using data from the Wave 1 (2003-04), Wave 2 (2006-08), and Wave 3 (2011-12) surveys, including analyses to assess risk factors for the development or persistence of serious respiratory and mental health conditions over time. A Wave 4 survey will be conducted using multiple survey modes to ascertain the health status and 9/11-related healthcare needs of the cohort 13-14 years after 9/11. The Registry will also extend the assessment of cancer and mortality incidence through 10 years post-9/11, investigate potential emerging health conditions through public health surveillance and follow-up studies (including collaborations with the WTC Health Program and other external researchers), and continue outreach to encourage enrollees to access monitoring and treatment through the WTC Health Program.

Project Number: 1U01 OH010412-01Institution: Albert Einstein College of Medicine Principal Investigator: Charles Hall, PhDPhone Number: 917-803-5470Email:charles.hall@einstein.yu.eduProject Duration: 2 yearsDescription:
The study uses innovative statistical methods – parametric survival models with change points – to study the incidence of new onset obstructive airway disease (OAD) diagnoses and symptoms over the first ten years following WTC exposure, with the goal of determining the length of time that exposure response gradients are observed among exposed FDNY firefighters. This study will allow estimation of the length of time that a relatively short-term, high intensity exposure may be associated with incident respiratory illness.

Project Number: 1U01 OH010399-01Institution: North Shore—LIJ Health SystemPrincipal Investigator: Hyun Kim, ScDPhone Number: 516-465-2517Email:hkim8@nshs.eduProject Duration: 2 yearsDescription:
This study will comprehensively describe the overall physical, mental, and socioeconomic impact of the WTC disaster on responders, as well as identify the linkage between SES and health among WTC responders. Results from this study have the potential to make a significant public health impact through the identification of new diseases and high-risk groups within the WTC cohort, and aid future development of new guidelines for the implementation of an occupational health surveillance system for disasters, which is essential for disaster preparedness.

Project Number: 1U01 OH010415-01Institution: Rutgers Robert Wood Johnson Medical School Principal Investigator: Jag Sunderram, MDCo-Principal Investigator: Indu Ayappa, PhDInstitution: NYU School of Medicine Phone Number: 732-235-7038Email:sunderja@rwjms.rutgers.eduProject Duration: 4 years Description:
Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant morbidity and impact on quality of life that can be improved by treatment with continuous positive airway pressure (CPAP). This study will examine the role of nasal pathology in WTC responders in the development of OSA and its impact on their ability to use CPAP. The present study contributes to understanding the relationship of nasal /upper airway mechanisms to the development of sleep apnea in this population and explores the possibility of improving comfort and adherence to CPAP treatment by modifying how CPAP is delivered.

Project Number: 1U01 OH010405-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Juan Wisnivesky, MD, DrPHPhone Number: 212-824-7567Email:juan.wisnivesky@mssm.eduProject Duration: 2 yearsDescription:
Asthma is a common illness among WTC workers (9-year cumulative incidence ~28%) and is responsible for a high rate of morbidity and diminished quality of life in this population. However, there is limited data regarding the natural history or factors that contribute to asthma morbidity among WTC workers. The objective of this study is to examine the natural history, self-management, and impact of physical and mental health comorbidities on asthma morbidity among WTC rescue and recovery workers.

Project Number: 1U01 OH010401-01Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Rafael E. de la Hoz, MDPhone Number: 212-241-8871Email:Lilliam.Medina@mssm.eduProject Duration: 4 yearsDescription:
The overall goal of this study is to identify the early manifestations of lung disease among the WTC workers and volunteers, as well as investigate their risk factors. The study team will perform standardized and computer-assisted readings of all chest CT scans received by WTC workers and volunteers at the Mount Sinai Medical Center since January 2003; assess the findings in a systematic way; evaluate the correlation of findings with clinical, functional, and exposure indicators; and develop a protocol for continued radiological surveillance of this cohort.

Project Number: 1U01 OH010413-01Institution: New York State Psychiatric Institute Principal Investigator: Christina W. Hoven, DrPH, MPHPhone Number: 646-774-5800Email:ch42@columbia.edu; doant@nyspi.columbia.eduProject Duration: 2 yearsDescription:
This study will examine patterns of mental health service utilization, barriers to mental health treatment services, and the factors associated with such use by youth who were exposed to the WTC attack. The study findings will provide guidance to the improvement of mental health intervention for these youth and will help in preparedness efforts for future terrorist attacks.

Project Number: 1U01 OH010414-01Institution: New York State Psychiatric Institute Principal Investigator: Christina W. Hoven, DrPH, MPHPhone Number: 646-774-5800Email:ch42@columbia.edu; doant@nyspi.columbia.eduProject Duration: 4 yearsDescription:
Worldwide Public Health concern about disaster and its long-term consequences on mental health remains an important but inadequately addressed issue. This study examines the mental health, substance use and other risky behaviors, among children directly exposed to the 9/11 attack—current ages 12-24. The study is designed to obtain an-in depth assessment of these adolescents' and emerging adults' current level of need, with the intention of facilitating treatment, diagnosis and intervention, as well as to inform public policy.

Agreements Awarded in FY 2011

Contract Number: 200-2011-39412Institution: State University of New York at Stony Brook Principal Investigator: Evelyn Bromet, PhDPhone Number: 631-632-8853Email:evelyn.bromet@stonybrook.eduProject Duration: 3 yearsDescription:
The study objective is to test mechanisms thought to be responsible for the comorbidity between psychiatric and medical sequelae of WTC exposures. We propose to study responders participating in the WTC-Health Programs. Of the entire cohort, approximately 16,000 completed the first two monitoring visits, about two years apart. In addition to routine questionnaires completed by responders at their monitoring visits, we conduct standard interviews designed to diagnose WTC-related PTSD. The longitudinal data will allow us to evaluate potential mechanisms underlying the links between mental and physical disorders.

Contract Number: 200-2011-41815Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Paolo Boffetta, MDPhone Number: 212-659-1474Email:paolo.boffetta@mssm.eduProject Duration: 3 yearsDescription:
The overarching objective of the project is to define whether WTC responders included in the WTCHP experienced an increased risk of cancer and whether or not such increase can be associated with WTC-related exposures. The specific aims of the project are: 1) to identify and confirm all cases of cancer occurring among WTC responders included in WTCHP, using multiple sources of information and developing algorithms for confirmation of cancer diagnosis. 2) to develop and apply an exposure assessment procedure to estimate Exposure Ranking Indices (ERIs) for selected known and suspected carcinogens for all WTCHP responders, and to conduct a systematic analysis of exposure-cancer associations, based on ERIs. 3) to conduct in-depth analyses of exposure-cancer associations.

Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens.

Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001.

Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure.

Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders.

Cardiovascular Health Impact and Prediction of Incident (primary and subsequent) Cardiovascular Events among WTC Responders(See more / See less)

Contract Number: 200-2011-41826Institution: Center for the Biology of Natural Systems (CBNS) Queens College-CUNY Principal Investigator: Alfredo Morabia, MDPhone Number: 718-670-4182Email:zlaskaris@qc.cuny.edu; alfredo.morabia@qc.cuny.eduProject Duration: 3 yearsDescription:
This cohort study will assess conventional CVD determinants, 9/11-related dust exposure, and PTSD, of 6,503 participants of the Mt. Sinai and North Shore LIJ WTCHPs recruited between January 2012 and June, 2013. We will follow the cohort for incident CVD during the subsequent two years, 2013 and 2014. Cardiovascular risk has been obtained from questionnaires and clinical exams. The on-going follow-up will track all incident events over two years by direct contact with the participants. Validation of events will be performed by obtaining hospital discharge and outpatient medical records, patient electronic databases (Statewide Planning and Research Cooperative System-SPARCS), and death certificates. In addition to its direct relevance for the health surveillance of WTC workers, this project will accrue new knowledge on the long-term effects of a major environmental disaster on the cardiovascular health of rescue, recovery, and clean-up workers.

Contract Number: 200-2011-39489Institution: Fire Department of New York Principal Investigator: David Prezant, MDPhone Number: 718-999-2696Email:prezand@fdny.nyc.govProject Duration: 3 yearsDescription:
The main objective of this three-year research project is to analyze the cohorts of FDNY firefighters and EMS workers, both WTC-exposed and non-WTC exposed in order to compare cancer incidence by WTC-exposure status during the early post-9/11 years. To achieve this objective, we intend to conduct longitudinal surveillance of cancer diagnoses in WTC-exposed and non-WTC-exposed individuals through 2008 and later, as data become available.

Background: The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up.

Methods: We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumor registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with over dispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria.

Findings: Compared with the general male population in the USA with a similar demographic mix, the standardized incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1.10 (95% CI 0.98–1.25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1.19 (95% CI 0.96–1.47) corrected for possible surveillance bias and 1.32 (1.07–1.62) without correction for surveillance bias. Secondary analyses showed similar effect sizes. Interpretation: We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies.

Contract Number: 200-2011- 42057Institution: State University of New York at Stony Brook Principal Investigator: Evelyn Bromet, PhDPhone Number: 631-632-8853Email:evelyn.bromet@stonybrook.eduProject Duration: 3 yearsDescription:
The objective of this study is to adapt and test an enhanced smoking cessation treatment for WTC responders burdened with PTSD symptoms. We will recruit 100 smokers who have significant PTSD symptoms from the population monitored at the Long Island site of the WTC-Health Program and other responders in the NY metropolitan area with PTSD symptoms. We will over-sample patients with lower respiratory illness to ensure that at least two thirds have these symptoms. Participants are randomly assigned to either: (1) standard smoking cessation or (2) enhanced smoking cessation that addresses PTSD and other anxiety symptoms. Nicotine replacement therapy is administered to both groups.

Contract Number: 200-2011-39413Institution: New York University School of Medicine Principal Investigator: Kenneth BergerPhone Number: 212-263-6407, 212-562-3752Email:kenneth.berger@nyumc.orgProject Duration: 3 yearsDescription:
The goal of the present proposal is to enhance characterization of World Trade Center (WTC) related lung disease using lung function measurements that can detect lung injury in addition to abnormalities identified in standard spirometry. The studies are based on the concept that spirometry may identify airway injury as a reduction in lung volume or air flow, however, spirometry can often be normal even in symptomatic patients, particularly when injury is located in the distal airways.

Background: The present study (1) characterizes a physiologic phenotype (observable physical or biochemical characteristics) of restrictive dysfunction due to airway injury and (2) compares this phenotype to the phenotype of interstitial lung disease (ILD).

Conclusions: This study describes a distinct physiologic phenotype of restriction due to airway dysfunction. This pattern was observed following WTC dust exposure, has been reported in other clinical settings (eg, asthma), and should be incorporated into the definition of restrictive dysfunction.

Backgroud: Exposure to World Trade Center (WTC) dust and fumes is associated with the onset of asthma-like respiratory symptoms in rescue and recovery workers and exposed community members. Eosinophilic inflammation with increased lung and peripheral eosinophils has been described in subpopulations with asthma. We hypothesized that persistent asthma-like symptoms in WTC-exposed individuals would be associated with systemic inflammation characterized by peripheral eosinophils.

Methods: The WTC Environmental Health Center (WTC EHC) is a treatment program for local residents, local workers, and cleanup workers with presumed WTC-related symptoms. Patients undergo a standardized evaluation including questionnaires and complete blood count. Between September 2005 and March 2009, 2462 individuals enrolled in the program and were available for analysis. Individuals with preexisting respiratory symptoms or lung disease diagnoses prior to September 2001 and current or significant tobacco use were excluded.

Results: One thousand five hundred and seventeen individuals met the inclusion criteria. Patients had a mean age of 47 years, were mostly female (51%), and had a diverse race/ethnicity. Respiratory symptoms that developed after WTC dust/fume exposure and remained persistent included dyspnea on exertion (68%), cough (57%), chest tightness (47%), and wheeze (33%). A larger percentage of patients with wheeze had elevated peripheral eosinophils compared with those without wheeze (21% vs. 13%, p < .0001). Individuals with elevated peripheral eosinophils were more likely to have airflow obstruction on spirometry (16% vs. 7%, p = .0003).

Conclusion: Peripheral eosinophils were associated with wheeze and airflow obstruction in a diverse WTC-exposed population. These data suggest that eosinophils may participate in lung inflammation in this population with symptoms consistent with WTC-related asthma.

Liu, M., et al. (2012). "Longitudinal Spirometry Among Patients in a Treatment Program for Community Members with World Trade Center-related Illness." J Occup Environ Med 54(10): 1208-1213.

Objective: The course of lung function in community members exposed to World Trade Center (WTC) dust and fumes remains undefined. We studied longitudinal spirometry among patients in the WTC Environmental Health Center (WTCEHC) treatment program.

Methods: Observational study of 946 WTCEHC patients with repeated spirometry measures analyzed on the population as a whole and stratified by smoking status, initial spirometry pattern, and WTC-related exposure category.

Results: Improvement in forced vital capacity (54.4 mL/yr; 95% confidence interval, 45.0 to 63.8) and forced expiratory volume in 1 second (36.8 mL/yr; 95% confidence interval, 29.3 to 44.3) was noted for the population as a whole. Heavy smokers did not improve. Spirometry changes differed depending on initial spirometry pattern and exposure category.

Conclusion: These data demonstrate spirometry improvement in select populations suggesting reversibility in airway injury and reinforcing the importance of continued treatment.

Pulmonary Function Abnormalities, Diastolic Dysfunction and World Trade Center Exposure: Implications for Diagnosis and Treatment(See more / See less)

Contract Number: 200-2011-39405Institution: Icahn School of Medicine at Mount SinaiPrincipal Investigator: Maryann McLaughlin, MD, MPHPhone Number: 1-866-537-7107Email:cynara.maceda@mssm.edu or heather.n.beebe@mssm.eduProject Duration: 3 yearsDescription:
The present proposal seeks to determine the significance of the long-term effect of particulate matter (PM) on pulmonary and cardiovascular risk, and to fully evaluate the relationship between PM exposure, pulmonary function and cardiovascular health. We will evaluate the clinical and pathophysiologic outcomes of exposure including pulmonary function abnormalities, obstructive sleep apnea, imaging abnormalities and risk factors for cardiopulmonary disease. This study will provide critical information regarding risk of exposure to PM, risk factors for disease and potential for improvements in diagnosis and treatment.

Contract Number: 200-2011-41919Institutions: Icahn School of Medicine at Mount Sinai School of Medicine and the Yale School of Medicine Principal Investigators: Adriana Feder, MD, Robert Pietrzak, PhD, Steven Southwick, MDPhone Number: 212-659-9145Email:adriana.feder@mssm.eduProject Duration: 3 yearsDescription:
The objectives of this study are to (1) characterize longitudinal trajectories of WTC-related PTSD and depressive symptoms in WTC responders; (2) examine specific risk and protective determinants of these trajectories; and (3) identify personal and psychosocial factors associated with resilience and recovery trajectories, with the ultimate goal of maximizing preparedness and improving mental health outcomes in disaster responders. The study shall make use of the unique dataset collected prospectively at the World Trade Center Health Program, beginning in 2002, to study longitudinal trajectories of WTC-related PTSD and depressive symptoms in 10,800 cohort members who completed three monitoring visits at the WTC Health Program, each approximately two years apart.

Background: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders.

Method: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks.

Results: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories.

Conclusions: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri (near) - and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

Background: Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations.

Method: Data were analysed from 10835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11.

Results: CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyper-arousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time.

Conclusions: Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hyper-vigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyper-arousal symptoms in WTC and other disaster responders.